Summaries of health policy coverage from major news organizations

Blue Shield of California To Add New Quality Measures to Tiered Hospital System

Officials at Blue Shield of California yesterday announced that the company will add new quality measures to a year-old tiered hospital system and said that the system is "starting to influence where patients go for care," the Contra Costa Times reports (Silber, Contra Costa Times, 6/5). Under the system, Blue Shield HMO members admitted to hospitals not on a preferred list must pay $100 to $300 more per day. PPO members must pay about 10% more for hospitals not on the list (California Healthline, 1/31/02). Blue Shield determines which hospitals appear on the preferred list based on cost and some quality measures (California Healthline, 6/26/02). The new quality measures include the severity of illnesses of the patients that hospitals treat, with more consideration for facilities that care for sicker patients. In addition, Blue Shield has revised the system used to group hospitals into regions for cost comparisons; the company will divide the state into 32 regions rather than eight. The new quality measures will increase the total that Blue Shield uses in the tiered hospital system to 14, and company officials said that they will add more measures in the future. Blue Shield officials said that the tiered hospital plan has begun to prompt some members to reconsider which hospitals they visit. "It's very much on the margin at this time. But there's some evidence that people are starting to think about their decisions in a different way," which can reduce costs, David Joyner, senior vice president of network management at Blue Shield, said. The tiered hospital system also has allowed Blue Shield to negotiate improved contracts with some hospitals, Joyner said (Contra Costa Times, 6/5).

This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.